Sciatica is a word commonly used to describe pain, numbness, tingling and
symptoms of "pinched nerves in the spine" which runs down one
or both of the legs. However, Sciatica is not a very specific diagnosis
because it can stem from issues affecting the lower back, where pain can
travel down the sciatic nerve, the largest nerve in the body, through
the buttock and the back of the leg.
Top 9 Causes of Sciatica:
- Muscle spasm from overuse.
Age-related arthritis (degenerative disc disease) either of the joints of the spine or the hip and knee.
- Obesity because typically patients facing weight issues tend not to move
around as much which can make them more susceptible to back-related problems
due to inactivity.
- Stress such as moving, job issues, money issues, personal life and everyday things.
- Pinched nerves – the real kind – from spinal stenosis to disc
herniations. This can be diagnosed properly with an MRI
- Urinary tract infections or kidney stones.
- Pelvic illnesses like prostate infection or endometriosis or ovarian cysts.
- Vascular diseases and poor circulation.
- Way down the list towards the end are problems such as secondary or metastatic
tumors from breast or kidney or lung or prostate.
Muscle Spasms: Most Common Cause of Sciatic Pain
Muscle spasms are the most common and also the least likely to be linked
to any imaging I can perform other than a physical exam. I bring this
up because many people assume that if they are experiencing severe back
and leg pain they must have pinched nerves in their lower back.
This is often NOT the case, cannot be diagnosed effectively without an
MRI image, and can only be roughly estimated by X-rays. In fact, after
a thorough physical examination, if there are no findings of numbness,
weakness, muscle atrophy, reflex changes or nerve tension signs, the likelihood
of finding nerve compression within the spine on an MRI is less than 1 in 1500.
When your back and leg hurts, obviously it is of concern, but even in the
most severely painful cases (without the nerve signs I just mentioned)
so bad you can’t get out of bed, you can expect full recovery within
a week in more than 90% of cases. People often call the symptoms of muscle-related
lower back pain “sciatica” but it has mostly to do with spasms
from overuse of lower back muscles, poor posture, inadequate conditioning
or unusual muscular demands on the spine.
Intense Activity After Inactivity
Most patients can link their pain to a specific set of events –
intense bending stooping lifting or other loads on the spine after a period
of inactivity, or taking on a greater stress than is commonly experienced.
Classic scenario: 4 days of golf and range practice after 6 months of
no golfing. Or, cleaning out an attic of large pieces of furniture or
other junk when over the previous month, the most activity experienced
has been sitting at work or in the car. Other times there is actually
NO explanation and NO obvious triggering events. This can be really frustrating
for both doctor and patient but it isn’t that uncommon.
Do High Heels Cause Sciatica?
I’m often asked about high heels as a cause of sciatica. There’s
not much good evidence written about this, but heels are associated with
a lot of foot pain and eventual deformity. Flats are OK to wear especially
if you are on your feet for a long time. Platforms can be a good alternative
and not cause so much calf and heel tightness if worn daily. The message
is, heels themselves have NOT been shown to cause sciatica from disc herniations.
Getting Back to Normal Activities After Sciatic Pain
Patients ask how to return to normal activities after experiencing sciatic
pain. Assuming it is the run-of-the-mill back pain, 95% of my patients
should be able to get back to daily activities within a period of 2 weeks.
What’s the easiest form of exercise and the least expensive?
A pair of sneakers and a sidewalk . Think about it – both are widely
available, cheap, no special machinery necessary, available 24/7 pretty
much anywhere there is dry land. It’s low impact, tolerated well
even with arthritis and joint complaints, gets you out of the house and
away from your computer. I recommend easing into it in ½ mile increments.
Add in gentle lower back stretching, hamstring and calf stretches to pain
tolerance. Make sure the sneakers fit well, have plenty of cushioning
and good arch support.
A Friendly Reminder to Everyone
The best exercise is something that you can do do regularly, not just
after experiencing back pain. Patients often ask, “What exercises
can I do to treat this sciatic pain?” I usually respond that initially
after rest and gentle stretching, and time, that regular exercise is best
as a preventative measure. Three to five times a week for at least an
hour of aerobic exercise, core strengthening and stretching has been documented
in countless clinical trials as equally-or-more effective than physical
therapy, medication, injections or chiropractic.
Get out there regularly. Like mom said, eat a good diet, don’t smoke,
go to sleep early, and get plenty of exercise!
About Dr. Michael L. Gordon
Dr. Gordon is a board-certified orthopedic surgeon and fellowship-trained on spinal
cord injury, spinal reconstruction and rehabilitation. He specializes
in complex spinal reconstruction, disc replacement, spinal deformities
(such as scoliosis), and minimally invasive spine surgery to treat herniated
discs or kyphoplasty fractures.